ANATOMO-PHYSIOLOGICAL

features OF THE
GASTROINTESTINAL TRACT IN
CHILDREN
• The digestive system is a complex
digestive conveyor, on the well-
coordinated work of which the condition
of the child and his health are largely
dependent
• Age-related changes in the structure of
the digestive system and its functions are
inextricably linked with the characteristics
of the vital activity of the organism at each
stage of ontogenesis, with energy and
plastic needs.
 Function digestive system
• Digestion and absorption of nutrients
• Motor and transport tow truck
• Secretory and excretory, regulating homeostasis of
the enteral environment and the whole body
• Endogenous digestion and utilization of endogenous
substances due to the hydrolysis and absorption of
endogenous substrates and metabolites
• Metabolic (transformation and biosynthesis of
substances from endogenous and exogenous
substrates)
• Protective (epithelial and mucous barriers, immune
system, etc.)
• Regulatory through substrate, nervous and endocrine
regulation
 Embryogenesis digestive tract

7-8 days- formation of a closed tube (primary intestine)

from the endoderm

12 days- the division of the primary intestine into the intra-

embryonic part (digestive tract) and the extra-embryonic (yolk
sac)
3 week – oropharyngeal membrane fusion
4 week – the formation of various sections
of the anterior intestine - the pharynx, esophagus, stomach,
part of the duodenum 12, liver, pancreas,
the middle intestine - part of the duodenum 12, jejunum and
ileum,
hind intestine - all parts of the colon.

3 mon- fusion of the cloaca membrane.

Oral cavity
 Features oral cavity in children
• In newborns, the oral cavity is relatively small
• Alveolar processes are weakly expressed
• The vault of the hard palate is poorly expressed
• Language is relatively large
• Chewing muscles are well developed.
• There are lumps of Bisha in the thickness of the
cheeks.
• The epithelium is distinguished by tenderness
and some dryness, a tendency to candidiasis (pH
neutral)
• Mucous bright, profusely vascularized
• White-yellow dots, the so-called Bonovskie
nodules, are visible along the midline in a solid
sky
• A dense roller extends along the jaw processes
(Robin-Magitot fold)
• The visible part of the lip mucosa has a
transverse striation (Pfoundler-Lyushka rollers)
гOral cavity in newborns
 Features of salivation in children
• The salivary glands of the newborn are morphologically
formed In the first 3 months, saliva secretion is low, the
main role is ensuring the tightness of the oral cavity
• By 4-5 months, excessive salivation appears due to
insufficient maturity of the central mechanisms of
regulation of saliva secretion and swallowing
• Amylase activity is low, the maximum is reached by 2-7
years pH of saliva in children is 7.32; in adults, 6.4 In
children on artificial feeding and after feeding, the main
functions of saliva are the digestion of carbohydrates and
the formation of a food lump
• Newborn saliva is also a powerful factor in cytoprotection
and contains components of non-specific protection
(lysozyme, prostaglandins, lactic acid, and others).
 Пищевод

Сегменты
пищевода

1-трахеальный,2-аортальный,3-межаортальный,4-бронхиальный,5-
подбронхиальный,6-ретроперикардиальный,7-наддиафрагмальный,8-
диафрагмальный,9-брюшной
 Features of the esophagus in children.
• The lumen of the esophagus is formed from 3-4
months of intrauterine life
• The entrance to the esophagus in the newborn is
located at the disc level between the third and fourth
cervical vertebrae and gradually decreases with age
• Anatomical narrowing of the esophagus in children
of the first year is weakly expressed
• The diameter of the esophagus of the newborn is 5
mm., At 6 months-8-10 mm., At 1 year-12 mm., At 15
years-18-19 mm.
• The transition of the esophagus into the stomach
during all periods of childhood is located at the level
of the tenth to eleventh thoracic vertebrae
Строение желудка взрослого человека
Stomach in the newborn
 features of the stomach in children
• The physiological volume of the stomach of the
newborn is 7 ml., For 4 days -40-50 ml., For 10
days-80 ml., In 1 year-250 ml., 3years-400-600 ml.,
10years-1500 ml.
• The newborn has a poorly developed bottom and
cardiac section of the stomach, the final formation
of which occurs by 8 years
• The inlet of the stomach is located above the
diaphragm and is located in the chest cavity
• The newborn has a well-developed pyloric
stomach
• The stomach of the newborn is located in the
oblique frontal plane, its bottom in the supine
position is below the anthropyloric department
• The mucous membrane of the stomach is relatively
thicker
• The pancreas of the newborn is not functionally and
morphologically developed, the number of glands per
1 kg. body weight 2.5 times less than an adult
• The gastric secretion in the newborn is low, the
intragastric pH is not lower than 4. By 1 year, the pH
decreases to 1.5-2.
• Neurohumoral regulation of gastric secretion begins
from 1 month of life, up to two months the source of
hydrogen ions is lactic acid and only later
hydrochloric
• Among the proteolytic enzymes, the action of renin
(chymosin) and gastricin predominates.
• The activity of gastric lipase, hydrolyzing fats in a
neutral environment without the presence of bile
acids, is high.
• A third of the breast milk fat is hydrolyzed in the
stomach.
Гистологическая картина нормальной
слизистой оболочки желудка ребенка
 Рancreas

Pancreatic secretion
Proteinases (trypsinogen, chymotrypsinogen A, B
and C, carboxypeptidases A and B,
proelastase and zymogen phospholipase A.
Lipase Amylase
Mucin Bicarbonates providing pH = 6.8-8
 Distinguishing features of the pancreas in
children
• In newborns and children in the first months of life,
insufficient differentiation of the gland
• Abundant vascularization is noted, little connective
tissue
• The mass of the gland at birth is 3 g., The most intensive
development and growth is from 6 months. up to 2
years. 5-10 years-weight 30-35g., 15 years-50g.
• Proteolytic activity in the newborn is high, increases to a
maximum by 4-6 years
• Lipolytic activity increases by 1 year and remains high up
to 9 years
• Amylolytic activity from birth to 1 year increases 4 times,
maximum at 6-9 years
• The activity of enzymes is adaptive in nature; with
natural feeding, their concentration is low, with mixed
feeding it increases by 1.5-2 times, and with artificial
feeding it increases by 4-5 times.
Печень
 Features of the liver and biliary tract in children

• The liver of a newborn takes from a third to half the volume

of the abdominal cavity, its mass is 4.38% of body weight
• The left lobe of the liver to birth is very massive, by 18
months its relative sizes are decreasing
• The growth rate of the child’s liver is behind the body
weight: by the age of 16, the weight of the liver increases
10 times, the weight 20 times
• In children under 5-7 years, the edge of the liver from
under the costal arch is normally palpated, and up to 2-3
years, by 2-3 cm.
• Lobules of the liver are not clearly delimited, their final
differentiation ends by 1 month. of life
• The fibrous capsule of the liver in newborns is thin, there
are delicate collagen and thin elastic fibers
• The composition of the newborn’s liver contains more
water, less protein, fat and glycogen, at the same time,
“glycogen capacity” is increased in the first three months
 LIVER FUNCTIONS
1. Biosynthesis of substances functioning and used in
other organs:
- blood plasma proteins
- glucose
- Fat
- ketone bodies, etc.
2. Urea biosynthesis as a final product of nitrogen
metabolism in the body
3. Digestive function associated with the synthesis of acids,
the formation and secretion of bile
4. The neutralization of toxic substances generated in the
body and coming from outside
5. Isolation of some metabolic products with bile into the
intestine (excess cholesterol, heme breakdown products -
bile pigments and other metabolites resulting from the
neutralization of substances in the liver.
The gall bladder in a newborn is hidden by the liver    
Its length at the age of 2-7 years is no more than 2.5-
4cm. 8-12 years old-5cm    13-15 years-7cm.    
Maximum Width-3cm

Newborn children are prone to cholestasis due to:

• immaturity of the enzymatic systems of the liver

reduced transport of bile acids insufficient
synthesis of bile acids dominance of cholestatic
fractions of bile acids (taurocholic acid
 Conjugation jaundice of newborns (physiological)

-physiological hemolysis
- insufficient glucuronyl transferase activity
- low activity and lack of synthesis of transport protein in
newborns
- develops on the 2nd day
- max for 4-5 days
- disappears by 7-10 days
- in premature infants
- - up to 4 weeks Jaundice in newborns with bilirubin level
> 68.4 - 85.5 μmol / L in children older than 1 year> 20.5
- - 34.2 μmol / l
- Bilirubin encephalopathy in premature infants at a
bilirubin level> 205 μmol / L
 Intestine Small
• In a child of 1 year of life,
the length of the small
intestine is 2 times less.
Than in an adult (1.2-2.8
m.)
• For 1 kg of body weight in
a newborn, 1 m. Of
bowels falls, in an adult -
10 cm. The surface area
of ​the small intestine in
newborns is 85cm²., In
adults-3.3 · 10³cm.²
• The surface area of ​the
small intestine increases
due to circular folds, villi
and microvilli.
 Intestine
• In the third month of fetal development, a bowel turn
occurs
• The degree of reduction of the yolk sac is different (Meckel
diverticulum)
• By birth, the intestinal length is relatively longer than in
older children and adults
• Circular folds in the newborn are expressed only in the
initial part of the ileum
• The length of the duodenum is 7.5-10 cm for him, 24-
30 cm for an adult. Intestinal loops are more compact
• Children under 1 year of age have weak ileocecal valve
• Young children have a longer mesentery
• The mucous membrane is thin, profusely vascularized,
highly permeable
• Epithelial cells are updated rapidly
• The intestinal glands are larger than in adults, the
lymphoid tissue is scattered throughout the intestines,
later it is grouped in the ileum
 Food conveyor stages

• The main link of digestion in a young child is parietal, membrane digestion

carried out by its own enterocyte enzymes and pancreatic, salivary, gastric
epithelium enzymes absorbed by various layers of glycocalyx. The activity of
intestinal enzymes in a child is high. Intracellular digestion is more
pronounced.
 Own enzymes of the small intestine mucosa
Glycosidases: Maltase-glucoamylase                               
Saharaza isomaltase                              
  Lactase-florizine hydrolase                              
  Tregalase      
Peptidases
Aminopeptidase A                               
Aminopeptidase N                              
  Aminopeptidase W                               
Carboxypeptidase P                               
Dipeptidyl aminopeptidase IV                              
  Peptidyl dipeptidase                           
     Pteroyl polyglutamate hydrolase                              
  Enteropeptidase                               
Enteropeptidase 24.11                               
Endopeptidase-2                               
γ-glutamyl transferase       
Phosphatases Alkaline phosphatase                               
Phosphodiesterase 1        unknown function 140kDa – glycoprotein        guanylate cyclas
regulators                                
Phospholipase A
 Absorption of
nutrients in the small
intestine

• In the first days, weeks

and months of a child’s
life, all sections of the
small intestine have high
hydrolytic and absorption
activity, and only later
does the proximal sections
prevail in the absorption of
nutrients
 Colon

• The development of the colon at the time of birth is not completed

• The tapes are barely visible, the haustra are absent for up to 6 months
• Up to 4 years old, the ascending colon is longer than the descending colon
• The mesentery is mobile, only 2% of newborns are fixed
• The sigmoid colon is longer, more mobile and located higher
 Features of the rectum in children
• In young children, the rectum is long;
when filled, it may occupy a small
pelvis
• The final position of the rectum is
from 2 years
• The rectal ampoule is not developed
• Anal posts and sinuses not formed
• Fatty tissue is not developed, the
intestine is poorly fixed
• The submucosa is well developed.
• The muscle layer is poorly developed
 Functions of the colon in
children
• Motor function in young children is
unstable
• Evacuation-reservoir reduced
(young children do not control the
act of defecation)
• Water resorption
• Digestive (normal microflora takes
part in digestion, fermenting
lactose)
• Other functions of intestinal
microflora (immunological,
protective, trophic, vitamin
synthesis, participation in the
circulation of bile acids,
inactivation of physiologically
active substances and enzymes.
The composition of the intestinal
microflora in children
The composition of the microflora of
the gastrointestinal tract in children
Моторика ЖКТ у детей
Normal stool frequency in children:
the first months of life - up to 7 times a day
the first years of life - 2-3 times a day
preschoolers - 1-2 times a day
schoolchildren - the interval between bowel movements 32-
48 hours
CONSTIPATION (constipation) - violation of independent
bowel movement - delayed, obstructed, insufficient Roman
Criteria II 1998. Constipation
- 2 symptoms and> of 4      - pronounced straining during
bowel movements
- - feeling of incomplete bowel movement
- excretion of solid and dry feces
- the number of bowel movements less than 3 per week
DIARRHEA - rapid bowel movement with increased water
content in feces
In young children, diarrhea: - stool volume> 15 g / kg per day
3 years and older: - stool volume> 200 g per day - frequency>
2 times a day
Diarrhea with polyfecia: - fecal volume> 2% of food eaten and
liquid drunk
The main components of the immune
system of the gastrointestinal tract
 Some common features of the digestive system
• Great variety of individual morphological and functional
variants of the structure and organization of work of
individual elements of the system
• There is an excess power of many elements (in the midst
of digestion, no more than a third of the total pool of
enterocytic enzymes is involved)
• The regulation mechanisms are presented and repeatedly
duplicated at the level of nervous, hormonal, substrate
regulation and are able to work autonomously
• There is a morphofunctional dependence of various
elements of the system, which creates a margin of safety
and provides adaptation when turning off certain
departments
• The system operates continuously and has circadian
rhythmic activity
• The normal functioning of the digestive tract depends on
the sufficient intake of nutrients from the blood. And also
substrates from the enteral environment
 The child’s digestive system is in development and is generally
characterized by:   
•    relatively large in comparison with adult sizes of individual segments of
the digestive tube relative to the surface of the body;
• the wealth of vascularization of the mucous membrane, its increased
permeability, high rates of regeneration;
• insufficient development of muscle and elastic tissue;
• a less pronounced connection between the intrinsic layer of the mucous
membrane and the submucosal layer, insufficiency of elements fixing the
intestines (muscle-ligamentous structures);
• A significant decrease in gastric digestion and the activity of enzymes of
digestive digestion, a shift in the maximum level of digestive secretion in
the direction of the distal gastrointestinal tract good adaptability of
secretory structures to the composition of food;
• partial hydrolysis of proteins, fats and carbohydrates due to enzymes of
human milk; significant specific gravity of intracellular digestion;
• the predominance of vagal influences on the motor function of the
intestine;
• immaturity of local defense systems, both specific and non-specific